| NPI | 1194393702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26127) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT na) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2022-06-24 |